Provider Demographics
NPI:1477021269
Name:CARSON, NANCY NJENGA
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NJENGA
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N HIGHLAND AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7354
Mailing Address - Country:US
Mailing Address - Phone:903-209-8813
Mailing Address - Fax:
Practice Address - Street 1:900 SWAN RIDGE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-8418
Practice Address - Country:US
Practice Address - Phone:903-209-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138543363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology